Healthcare Provider Details

I. General information

NPI: 1790387264
Provider Name (Legal Business Name): NICHOLAS YIP LMSW, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL FL 12
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL FL 12
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: